Individuals who are poor or who suffer from problems related to alcohol or drug use can encounter negative social stigma when seeking medical care. Stigma related to poverty or substance use problems may result in negative consequences for affected individuals including delay or avoidance of needed medical care, exacerbation of treatable conditions, increased pain and suffering, and higher healthcare costs. A better understanding how healthcare organizations generate and/or ameliorate stigma associated with poverty and substance use problems may lead to positive interventions to reduce stigmatization of these vulnerable populations. The objective of this exploratory and developmental project is to examine how different healthcare organizations shape the stigma experiences of patients who are poor or have substance use problems. Qualitative research methods will be used to document how patients manage stigma and examine how these management strategies are affected by stigma processes in healthcare organizations. This study develops theoretical propositions to guide future research by identifying characteristics of healthcare organizations that affect stigmatization. The specific aims are: 1) to use ethnographic research in four healthcare organizations to describe how the behaviors of care-providers generate and/or ameliorate stigma related to poverty and substance use problems, 2) to use interviews with patients to describe how their interactions at each study clinic affect their strategies for managing stigma related to poverty and substance use problems, and 3) to identify the characteristics of healthcare organizations that are salient in the generation and/or amelioration of stigma related to poverty and substance use problems.